Dilation & Drug Decisions: How Cervical Dilation Can Impact Labor

Many thanks to Emily for sharing her beautiful birth story of her first baby, Ava. Emily had planned for an unmedicated birth, but when she learned that she was only three centimeters dilated after a day of hard labor, she opted for pain medications. Although the epidural provided relief, it led to severe hypotension and thus more medical interventions. Read on to learn how dilation informed Emily's decision-making during labor and her insightful reflections after the fact. Thank you, Emily, for sharing your story with us all.

By Emily Brereton

I’d had a physically easy pregnancy, no complications, and from the beginning I’d intended to go “all natural.” I’d done the research and read the horror stories of women rushed from intervention to intervention, of feeling out of control. I was adamant that I wanted this done my way, no matter what. If that included pain meds, so be it, but it would be at my request and they would be an absolute last resort.

My daughter Ava was due August 20th, and the last two months of my pregnancy were a blur of activity. We were renovating a new apartment, in the hot July sun, as payment for reduced rent. I spent that summer nailing baseboards, fixing window screens, with my stomach hanging out, sweating and bloated and exhausted.

I was feeling confident, but then came the waiting. I’d gained a whopping 60 pounds during my pregnancy and it was now August. Every day we looked for signs. Cramping? No. Mucus plug? Still in.

The Friday before I went into labor, I went to my last ob-gyn appointment. She asked if I wanted a cervical check. For a moment, I hesitated, knowing that dilation can start but labor could be far away, but I relented. And the news that I was 0.5 cm dilated still felt joyous. Something was happening. I didn’t know when, but she was coming. Eventually.

The next day I felt awful, hazy and hot and immobile, like a beached whale. Two hours after going to sleep, I woke up and ran to the bathroom. All night long, I had vomiting and diarrhea, so severe I could not sleep, and it continued until absolutely nothing remained in my system.

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In the morning, the baby stopped moving. I went in to my doctor's office for another ultrasound. Baby was head down, fluid levels were good, and she was “practice breathing.” They told me I was having contractions (which I couldn’t feel) and sent me home. Labor was imminent, but not happening. Everything was ok.

That night it happened again. Another night of no sleep. In the morning, I told my partner, Daniel, I was “cramping,” but then argued they weren’t contractions and insisted he go to work.

As the day progressed, the “cramps” got stronger. By 7:30 that night, they were solidly uncomfortable. I started rolling around on my birthing ball. I texted to inform Daniel, insisting he finish work, but he wasn’t having that. He rushed home and started packing. My contractions now took my breath away. They were still one minute in length every three minutes, but solidly painful. We called the nurse, but since I didn’t want pain meds and lived close by, they told me to stay home until they were ninety seconds apart.

Daniel and I went for a walk. It was 10:30 at night. Every ten feet we’d stop. I was vocal now. By the time we got back home, scarcely 20 minutes later, they were consistently 90 seconds apart and my screams were getting louder.

It was go time, I thought.

At this point, I still wanted to go natural. With my contractions so close together, it seemed possible. But at the hospital, after hooking me up to a bunch of monitors and forcing me on my back, they told me I was only 3 cm dilated. Only. Three. Centimeters.

I started to panic. I threw the oxygen monitor off my finger with the next contraction. I couldn’t do another whole day of this… of not sleeping, eating, or drinking, with contractions a minute apart!

Only. Three. Centimeters. I started to panic.
— Emily

I started pondering pain meds. My dreams of an effortless “natural” birth were gone. I was exhausted, dehydrated… And my nurse, bless her soul, answered my questions and encouraged me.

So I requested fentanyl. The first hour was glorious. Fentanyl let me rest. I could still feel the contractions, but the period between actually felt like a break. Previously, even that “break” hurt; everything had started feeling like one long contraction.I requested a second hour of fentanyl, but my contractions were stronger and it barely had an effect. At the end of the hour, not much more dilated, I was considering an epidural.

My fixation on dilation (coupled with dehydration and exhaustion) resulted in vastly more interventions than I intended.
— Emily

I started sobbing. It was irrational, but an epidural felt like an admittance of weakness, like somehow I was failing at this very first task of motherhood.

But it happened. With my mother on one side and Daniel on the other, I signed the consent form. And half an hour later, the pain was all gone.

At this point, unbeknownst to me, I was on my fourth or fifth IV bag of fluid, yet my urine was the color of rust. I learned later that “normal” was about four IV bags during labor, I totaled six or seven before my urine returned to a normal color, and eight in all.

It was now 3:30am. I laid in bed, completely motionless and very cold, but finally at rest. An emergency alarm on my monitors started going off and I ignored it. My blood pressure had dropped to 80/40. They upped my fluids, but my blood pressure did not change. They gave me ephedrine, and the warmth in my body suddenly returned.

They checked dilation... it hadn’t changed. They administered pitocin.
— Emily

At 6am, they checked dilation, 8 cm. At 9 am, it hadn’t changed. They administered pitocin.

At 11am, I was fully dilated. I “labored down” for an hour, and at 12:36 pm, after a grand total of three pushes, Ava Jayne was finally here.

She was perfect, 7 pounds 11 ounces, head full of hair, a picture of health. They laid her on my chest and all I could think was, “this is her. This is the kid that’s been messing with me for nine months.” It felt like meeting a pen pal. Bewildered, I didn’t know what to do, where to hold her, how to keep her safe…

It was a confusing moment. I didn’t have a “surging moment of infinite love;” it was more subtle than that. Here was this tiny person who needed me, who would always be here, and I loved her, but still didn’t know her, at all.

Distracted, I had torn, and I was bleeding a lot. They told me to keep pushing, their voices a bit strained.

“I know you don’t want to, but we need to get the placenta out to stop the bleeding.”

Another push or two and everything was all right. The placenta came out in one piece, they got me stitched up, and they removed the epidural and catheter. I walked again. They fed me. Even breastfeeding, while awkward and slightly uncomfortable, went pretty well. For all the hell of the past few days, everything was so good.

It felt like meeting a pen pal.
— Emily

Ava will be one year old next month. She’s toddling around using furniture and walls, climbing up stairs and ripping books, chasing cats and laughing a lot. And just like she was in the womb, she’s wildly inconsistent. Yet every day I love her more and more.

I think back to labor with mixed feelings. I loved my epidural, but I fought it so hard. And I ended up needing drug after drug… the antithesis of that “natural” birth I claimed to want so badly. In theory, I would try for natural again, but then I remember how, at only 3 cm dilated, I was contracting every two minutes. I wouldn’t have needed ephedrine if not for the epidural.  And maybe my labor wouldn’t have stalled at 8 cm and I wouldn’t have needed pitocin.

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It’s useless to ponder “what-ifs,” especially since I had a healthy vaginal birth. I was severley dehydrated, and dehydration causes cramping. Maybe if I’d just been farther along when they first checked my dilation (maybe six centimeters instead of three), I could have stuck it out unmedicated for longer. Knowing how little I had dilated had terrified me.

But above all, I had a healthy child and no lasting complications. Ava is the best thing I have ever done, and labor can’t get much better than that.